Individual
MS. CORONDA TYEAST CARTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
470 CHADBOURNE RD STE F, FAIRFIELD, CA 94534-9620
(707) 557-4560
(707) 557-7909
Mailing address
470 CHADBOURNE RD STE F, FAIRFIELD, CA 94534-9620
(707) 557-4560
(707) 557-7909
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
IMF79317
CA
101YM0800X
Mental Health Counselor
—
—
106H00000X
Marriage & Family Therapist
IMF55564
CA
390200000X
Student in an Organized Health Care Education/Training Program
IMF55564
CA
Other
Enumeration date
03/05/2007
Last updated
04/03/2017
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